1209 MADRONA AVE 2016-01-01 MF Import

Date� 1�Q0 Appl�cation For PUB�.IC WORKS PERMIT Print or Type Only Mailing Zip Pu�hc Works �eimll � �,/� PIaq.Depl.+ � PuLLc Wo�ks Pee Total Fee $ - Les5lo01 Fee PaiO g BalanceDue 5 ��_r asn- ��, /�.� � qpplicant Mailing Address Ci1y Zip Phone Describe Proposed Work ��i� �X ��N�� L��}��F Prolect Address (if known) nuach four 14) copies ot plans tor propo;ed work - Draw to scale and nole the lollowing as appii�able: • Property Lines • Outline and dimensions of aii exisung antl proposed strudures on ihe lo� • Exis�ing and proposed utilities • Centerlina ol stree� • Indicate North • Show any proposed gradinc� changes 11 Show measurements PERMIT CONDITIONS 1. All calls tor inspection shall be matle 24 hrs. in advance • phone 259•8810. 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Construction Standards and Specifications. 3. Call Location Underc�round Service 46 hrc. betore you dig. TOLL FREE NUMBER 1•800•424-5558. �i e a� lil��--�ZZ c - Approved lor Constru on Date �� U �� FINAL INSPECTION Date Approved as Construc�ed evere[t PUBLICVJORKSDEPAR7MEh.'T � 3200 Cedar Street Everett, WA 98201 Phone:259-BO10 ACKNOWLEDGEMENT OF CONDITIONS W � � � � O � � O a The undersiyned owner/aGPlicant hereby agrees to hold and save harm� less ihe City of Fveretl from any and all claims lor damages, cosls. expenses, or cauoes of aclion ihat may arise becausr, ol installation and maintenance of ihe improvement or other right�of�way use hereto applied for and lurther agrees to remove same upon notice Irom ihe Ciry and to r�lac� public pr�e1�Y d�2�maged thereby. WOR AUTHORI2E0 BY THIS PERMIT MUST BE ST.IRTED WITHIN 180 AYS OF DA1E PERMIT IS ISSUED AND THEREAFTER IS TO BE ILIGENTLY PURSUE� TO COMPLETION. THIS PERMIT MAY BC- CANC[LLED BY THE CITY UPON AIJY STOFPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIOW.